1. Developing a Donor Resource Team
Cindy Kolzow, RN / Donation Liaison
Ministry St. Joseph’s Hospital-Marshfield
Doug Miller Symposium, April 25, 2013

2. Ministry Life Gift Team
Cindy Kolzow, RN
Heather Schmidt, RN
Jean LaMaide, MICU RN
Lacie Pohl, SICU RN
Libby Ferris, OR RN
Alison Harycki, PICU RN
Sara Strell, UW OTD
Tracie Cook, UW OTD
Rupal Shah, RT
Jenny LaPoint, RT
Dr. Jesse Corry, Neurointensivist
Lindy Nelson, Chaplain

3. Vision
MSJH will have a multidisciplinary patient-centered approach to the donation process involving spiritual services, nursing, and physician staff that will result in a well coordinated, seamless consent process benefiting families, patients, staff, and recipients.

4. Analysis 13 potential donors (non-donors) in 2011
Completed root cause gap analysis to determine the whys
MSJH has over 120 trained designated requestors across 3 critical care units
Few are confident in their knowledge of the donation process and approaching families about donation
Resulting in poor consent processes and decreased consent for donation
Reviewed 2 recent cases that went well
Expert nurse coordinating the care
2:1 nurse ratio in caring for patient
Huddle process in place prior to consent discuss
Key MDs who understood donation process

5. Changes
Created multidisciplinary communication worksheet for organ referral patients
Development of donor resource team
(DOT- Donor Organ Team)

6. Orange Communication Worksheet
Tool to facilitate communication between providers and shifts
Initiated when patient meets clinical triggers
Updated with donation information as appropriate
Not permanent part of medical record but kept in front medical chart
Orange  - you can’t miss it!

7. DOT (Donor Organ Team)
Resource team with expertise in the donation process
Role:
Coordinate huddle to best facilitate consent process with consistent, accurate donation information
Assist with resource management of the consent process

8. DOT - Where Did We Start?
Obtained administrative support for the project and potential on call schedule
Modeled after the SANE program in the ER
Identified core team members with critical care background as members
Developed education for team

9. DOT Member Selection 12 RNs from the PICU, MICU, SICU, and management
DOT members have:
Critical care experience
Vested interest in donation
Good communication skills (esp. EOL issues)
Varied work schedules for adequate coverage

10. Ministry St. Joseph’s DOT Members
Cindy Kolzow, Donation Liaison
Annette Hansen, MICU RN
Tiffany King, MICU RN
Heather Haun, Peds ICU RN
Reesa Mitchell, Peds ICU RN
Stacey Larson, House Sup RN
Sherrie Lancour, MICU RN
Jean LaMaide, MICU RN
Lacie Pohl, SICU RN
Greg Schield, SICU RN
Heather Schmidt, MICU Mgr
Thora Tollefson, SICU RN

11. When Is DOT Contacted? Family brings up donation
A family conference is being planned for grave prognosis or withdrawal of care
When the option to donate is in question

12. How Contacted?
Critical care charge RNs and house supervisors have DOT members’ contact information
Assess 1st in-house resources
M-F days, management members available
DOT working on unit and able to assist
House supervisor to assess availability of DOT member in another unit
Otherwise, contact a member on the list at home

13. Expectation of DOT Member When One Receives a Call
Call unit to query where we are in the process of donation
Is patient BD?
Is there a plan to withdraw care?
Any request/mention made by MD?
Family questioning organ donation?
Does patient have first person authorization?
Develop plan for next steps (come in, watch and wait, etc).

14. Initiate huddle - ensure all disciplines are aware of the donation process
Provide real-time education for nursing, MDs, spiritual care, etc.
Be the designator requestor

15. Assist with coordination of care beyond the consent process, if able
Serologies
Heart & lung procurement work-ups
Attend monthly meetings
Case review
Continuing education/process improvement

16. Education of DOT Members
Survey to assess education gaps (Wide variation of knowledge!)
One 8-hour training day
Roles and expectations
Consent process
Overall donation process
Effective requesting strategies
Role playing
Difficult situations

17. Key Learnings: Orange Sheet
Valued by staff – in patient’s paper chart so easy to update and maintain
Not part of the patient’s permanent medical chart
Roll-out to units was inconsistent so sheet is not always pulled
Sheet gives little instruction to bedside nurse on contacting DOT/next steps

18. Key Learnings: DOT Team
Improved year-over-year regulatory and true conversion rates and consent rate
DOT role focused on consent process -> serologies, not the whole case, so not a huge tax on the “system”
Little knowledge of DOT’s existence by MSJH at large. DOT not consistently notified.
Monthly DOT meetings are poorly attended – keeping the core team “connected” has been difficult

19. Next Steps Make MSJH aware of DOT team
Ensure DOT members can attend monthly meetings and in-services
Establish criteria for what is a “good no” for consent versus an opportunity to improve
Revise orange sheet and internal website for donation info/resources

20. Questions?